How to Pay for Home Health Care

There is an evolution happening in health care. Providers realize that individual patients and families want more control and ownership over their own health. Whatever our medical circumstance, we all want the best possible outcomes, well-being, and quality of life, and there is a growing recognition that all of those things are best attained with the love and support systems available at home and in our own communities.

As hospital stays get shorter and more neighborhood health centers become available, home is where most of our health care and healing is taking place. And a great benefit of this trend is that each client receives personal, one-on-one attention from their nurses, therapists, and other caregivers, paying for exactly the services they need and nothing they don’t.

The Home Health Care Solution

Whether you require ‘round-the-clock nursing care, short-term recovery care, companionship, or just help with personal care and housekeeping, home health care services can help keep you living safely in the home of your choice with comfort, independence, and dignity. A trusted home care team can provide:

• One-on-one consultation and education to help set and achieve personal health goals
• Coordinated, real-time management of health care services and medical supplies
• Oversight of everyday safety precautions
• Regular health monitoring to reduce medical complications and unnecessary hospitalizations

Cost of Home Care Services

More and more clients and families are choosing high-quality, compassionate home health care services as their right-sized, cost-effective solution to help them thrive at home and enjoy their best quality of life. Let’s explore your payment options.

Paying for Home Health Care: Understand Your Options

Many home health care agencies accept a variety of payment options and often are willing to work with your family to plan appropriate financing and to coordinate insurance payments. Some of the best providers will offer to explain and handle your insurance benefits for you, and in some cases, even direct bill payors to alleviate the need for advance payments and reimbursements.

You or a loved one may qualify for home health care benefits through one or more of the following options:

Medicare. Medicare is one of the largest payors of home health care services. To be eligible, you must be age 65 or over, or defined as “disabled” for two years for Social Security purposes. The Medicare home health benefit is designed to help with recovery from an injury or illness, to manage a chronic condition, or to help with other short-term, intermittent needs. It may cover a range of skilled care services such as nursing, physical therapy, occupational therapy, and speech therapy. Home health aide services (a.k.a. personal care or assistive care) are sometimes covered if deemed necessary along with skilled services. A physician’s referral is always required for care. For the U.S. government’s full summary of Medicare home health care benefits see www.medicare.gov/coverage/home-health-services.

Veterans benefits. If you or loved ones served in the military or were called to active duty while a member of the Reserves or National Guard, he or she may qualify for Veterans Administration (VA) health care benefits. Home or community care is one of the health care services that may be covered by VA benefits. Eligibility is determined based on a patient’s need for ongoing treatment, personal care, and assistance. The VA may also consider other factors such as income level, ability to pay, disability status, and existing insurance coverage when assessing eligibility. For more detailed information, see www.va.gov/healthbenefits/apply/veterans.asp.

Medicaid. Every state has a government program that provides medical assistance to people who meet income eligibility requirements. If Social Security is your primary source of income and your home is your main asset, you may meet Medicaid requirements. The Affordable Care Act made it easier to apply for Medicaid, and it standardized modified adjusted gross income (MAGI) as the basis for determining eligibility for this and other tax credit and cost reduction programs. In addition, some states chose to expand their Medicaid coverage for low-income adults. An attorney may be able to provide guidance on eligibility requirements. Qualifications vary from state to state, but general information about eligibility is available at www.medicaid.gov/medicaid/eligibility.

Long-term care insurance. If you or loved ones have been contributing to a long-term insurance plan, it may be time to take advantage of it. Otherwise, it may be difficult to enroll in a long-term insurance policy if you’re in poor health or currently require long-term care. Nevertheless, check with an insurance provider to learn more about what plans and premiums may be available.

Private health Insurance. If you or loved ones have private health insurance, check your policy coverage for home health care, as it varies from plan to plan. Most private insurers will cover the costs of short-term skilled nursing care after a surgery or an injury not directly related to an auto or workers compensation accident. High deductible plans tied to health savings accounts may offer tax advantages, so ask about that benefit as well.

Private pay. Some families choose to pay for home health care expenses out-of-pocket. Retirement income, savings, stocks, home equity, or gifts from family members are all possible sources to help cover the cost of home health care. If you do choose to pay out-of-pocket, discuss the benefits of the various sources with an attorney or financial advisor. And if you do choose to pay privately, most home health care agencies are happy to work out payment terms with you.

Other sources. If you or loved ones require care and/or rehabilitation because of an auto accident or job-related injury, then workers compensation, auto insurance, an employer or consumer insurance plan may pay for home health care services.

The Bottom Line

There are several options available to help pay for home health care, making it an affordable choice for many people. When you contact potential home health care providers, ask 1) if they participate with a variety of health insurance payors, 2) if they can accept “assignment of benefits” to alleviate your family from making advance payments, and 3) if they’re willing to work with you to coordinate your benefits or private payment plan. Most professional providers will be happy to provide these complimentary services to make your transition simple and easy.

Finding a solution that works for your family now will make it seamless to adjust your care plan as needs change. That’s how affordable, personalized, high-quality care in the comfort of home can mean safety, independence, and peace of mind for you and your family.